Provider Demographics
NPI:1407217961
Name:FEDEWA, VALERIE (DC)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:
Last Name:FEDEWA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:HART
Mailing Address - State:MI
Mailing Address - Zip Code:49420-1248
Mailing Address - Country:US
Mailing Address - Phone:231-301-8383
Mailing Address - Fax:231-903-6467
Practice Address - Street 1:1122 S STATE ST
Practice Address - Street 2:
Practice Address - City:HART
Practice Address - State:MI
Practice Address - Zip Code:49420-1248
Practice Address - Country:US
Practice Address - Phone:231-301-8383
Practice Address - Fax:231-903-6467
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor